Title

Head and Neck Radiation Treatment is a Risk Factor for Implant Failure

Clinical Question

For a patient receiving a dental implant, does head and neck radiation therapy increase the risk of implant failure?

Clinical Bottom Line

There is an increased risk in implant failure for patients that undergo radiation therapy to the head and neck.

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
25242560	Chrcanovic/2014	2438 patients with irradiation to head and neck that have undergone dental implant therapy	Meta-Analysis
Key results	This meta-analysis concluded that irradiation has a negative effect on the survival of implants and that there is a lower success rate in the maxilla (19.19% failure) than the mandible (6.8% failure) in evaluation of 2438 patients. There is no significant difference if the implant is placed prior to or 12 months post-irradiation therapy. There is a lower survival rate the greater the amount of grays the patient is exposed to ( > 50 Gy), confirming a dose-dependent relationship between radiation and osseointegration failure. The use of hyperbaric oxygen therapy in irradiated patients did not have a significant effect on the outcome.
24271500	Schiegnitz/2014	Patients with irradiation to head and neck that have undergone dental implant therapy	Meta-Analysis
Key results	This study concluded that the mean implant survival rate was 83% with a range of 34% to 100%. In the current literature (2007-2013), there was not a statistically significant difference in implant survival (odds ratio = 1.44). In 1990-2006, there was a significant difference in survival rate (odds ratio = 2.12). The survival rates of implants placed in irradiated grafted bone was significantly lower than in irradiated native bone. Advancements in 3D imaging, implant surface technology, guided surgery, and complex treatment planning have contributed to the success in treating patients with a history of head and neck radiation. Dental implants are a valuable treatment option for these patients.
24158336	Chambrone/2014	Patients with irradiation to head and neck that have undergone dental implant therapy with or without hyperbaric oxygen therapy	Systematic review of non-randomized trials
Key results	This study concluded that the mean implant survival rate was 46.3% to 98% and estimated that the risk ratio for implant failure was 2.74 for patients that have undergone irradiation to the head and neck. There was an increase in risk of 5.96 if the implant was placed in the maxilla. Hyperbaric oxygen therapy did not reduce the risk of implant failure. However, this study concluded that dental implants are a good treatment option for patients that have been irradiated.

Evidence Search

PubMED Search; “Radiation Therapy Dental Implant” MeSH, “Radiation” MeSH “Dental Implant” MeSH.

Comments on
The Evidence

Validity: Even though these studies represent the highest level of evidence, there were still a lot of confounding factors that could have influenced the generalized outcome (Chrcanovic/2014). Some of the studies that the authors analyzed were underpowered (Chrcanovic/2014). In Chambrone/2014, most of the reported data was on machined implants, and only 3 included studies had patients that underwent hyperbaric oxygen therapy. Moreover, the definition for success of dental implants was not consistent across the different studies. Perspective: There is an increased risk of implant failure for patients that have received radiation therapy, however, dental implants can be a viable option for these patients.

Applicability

This information can help a dentist in treatment planning for patients that will be undergoing or have previously had radiation therapy. After reviewing these studies, dentist can provide information about the risks and benefits of treatment to the patient to allow him/her to make an informed decision.

Specialty

(Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)

Keywords

Radiation therapy, dental implants, success rate

ID#

2774

Date of submission

11/19/2014

E-mail

tatumc@uthscsa.edu

Author

Catherine Tatum, DDS

Co-author(s)

Co-author(s) e-mail

Faculty mentor

Guy Huynh-Ba, DDS

Faculty mentor e-mail

HuynhBa@uthscsa.edu

Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

None available